Centenary of Medical Social Work in Trinity College Dublin, 24th October 2019

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Thank you, Paula, for inviting me here this evening to speak at this joyous and celebratory marking of 100 years of Medical Social Work in Trinity College, Dublin

And before I begin, I must come clean. I am very much an imposter here. Unlike the distinguished Margaret Horne and everyone in the room, I am not nor never was a Medical Social Worker.

And my Social Science degree is from UCC, not TCD. Though, and on reflection, as I never held the title, I am and always have been a social worker by sensibility, by orientation, by world view, a social worker in disguise, if you will, in the very different roles and titles that I have held over my working life, including the one I currently hold

When I started out as a very ‘wet behind the ears’ social science student some 40 years ago this month, I wouldn’t have been aware that Medical Social Work would have been around for some 60 years before. Its birth and development mirroring the birth and development of the Irish State.

So, what was the Ireland, into which Medical Social Work began, like 100 years ago? And thank you so much Margaret for your many contributions in Ireland, in Zimbabwe, for your leadership and the development of our profession, and not least for your ‘Overview of Health-related Social Work in Ireland’, written with Erna O Connor, which I look forward to sitting down to read properly which these last few days did not allow I’m afraid.

I was trying to get a picture of Ireland 100 years ago, when the Medical Social Work in Trinity began and found it difficult to find precise data for 1919 but did find that the Infant Mortality rate in 1916 was 81.3, meaning that for every 1,000 births, 81 babies died before they reached a year old. To compare, the rate in 2014 was 3.6. So, things have gotten much better for babies in Ireland. Well, some babies anyway.

Housing was a problem then as now. Back then collapsing tenements but also the Housing (Ireland) Act of 1919, a post-World War I initiative by the British Government. The Act passed, and local authorities did surveys and showed a need for 60,000 plus homes but promises made were not implemented. Does this sound in way familiar or ring any bells?

The big killers of the time were bronchitis, pneumonia and TB. Infectious diseases like measles, scarlet fever, whopping cough, diphtheria and the flu took lives too. Not such big killers these days, even with anti vaxer propaganda. Unless of course you are a Traveller or a person experiencing homelessness. Heart disease was up there though not so much cancer as I guess diagnostics not as good then, and because people didn’t live long enough to get it.

Data from the CSO indicates that average life expectancy for men and women in 1916 was 53 years and 80.6 years in 2016. Though averages hide a lot. The life expectancy of a male Traveller today is 66 years and 42 years for a person who is homeless.

There were lots of small hospitals. So, lots of jobs for Medical Social Workers but perhaps only if you were a nun or religious. And maybe pay, not so much!

In 1919 there continued from the previous century Ireland’s love affair with incarceration. In 1914 almost 17,000 people were locked up in Asylums. Over 7,900 children lived in Industrial Schools in 1916 and 700 more in Reformatories.

Today we have hospital overcrowding and trollies. Then District Lunatic Asylums like one recorded in Castlebar being described by its Management Committee as reaching “appalling” levels. I know in 1919 the Workhouse in Macroom were I grew up was still in operation, closing in 1921 only because it burnt to the ground during the War of Independence.

A lot has happened in 100 years.

Some things strike me as pivotal.

After World War 2 there was a sea change in the social policy context in which social work including Medical Social Work takes place framed by the enlightened Beveridge Report and the fight against the five giant evils of






Let us reflect about the extent to which theses ‘5 Evils’ are still with us today?

And what about Daniel Dorling’s updated list from 2015, his ‘big 5 social evils’ are






Do we recognise these? From what you see and hear every day, do you have a Big 5 lists of your own?

So much has changed in 100 years and somethings not so much at all

We have better names for things now, finally naming things we all knew, hidden in plain sight like Coercive Control or the impact of Adverse Childhood Experiences, across lives

Today we can be more “evidence based” – mostly good if not based on ‘rubbish in’ or ‘biased in’ data…..surely reproducing rubbish out and biased our findings or even used as a political excuse for inaction, delay or indifference

C.W, Mills construct from the Sociological Imagination, that private troubles are public issues, still holds for me most days. The personal is most definitely political.

Then. Now. Always

Social Workers are witness to and try to ameliorate private troubles and so public issues.

You witness in hospitals babies dying because of poverty and social exclusion

You witness in hospitals older people unable to go home because we do not have an infrastructure of homecare like other small countries like ours can somehow afford

You witness people young and old experiencing harm and abuse in the domestic realm, physical and psychological, with few safeguards or protection

You witness in hospitals sick people, physically and mentally discharged to at best emergency accommodation at worst the streets without help, treatment or support

You witness children and adults with disabilities without the personal assistance or life-giving chairs or beds they need or other adaptations or supports

You witness people with conditions like MS not getting the rehab they need

You witness vulnerable children self-harming without the cotton wool of love and support they need wrapped all around them. Children discharged to hubs, hotels or direct provision. Their accident of birth

You witness people with dementia getting a diagnosis and not much more

……. You see it all. You hear it all. Sometimes it’s just too much. You do your best

Its important that although we work in systems, we must always, always make the systems work for the people we serve. And whilst being mindful of boundaries, take care not to create social distances and barriers with the people on whose behalf we work.

I dislike and never use terms like clients, patients, service users and customers for those very reasons. For the mindset it may create though language

And it’s so important that you use, we use our unique place, to make the calls for change, loudly clearly as other groups like GPs, like the hospital consultants. Not so much for ourselves but for the people we are there to serve in 2019, in 1919 and for decades ahead.

It’s time to act politically. What are Medical Social Works’ Big 5 Evils or the IASW’s…. let’s hear about them

Social Work, once done with compassion and respect, informed and driven by values of social justice, equality and human rights, is maybe automation proofed. When we are at our best we are very hard to replace with a machine. Only though, once we keep the warmth and deep humanity that started off Medical Social Work 100 years ago. Preserving these values in our everyday encounters with people experiencing want, living in squalor, people subjected to prejudice.

People in despair.

This core will keep us relevant, useful and on the right side of history for the next 100 years, changing the world for the better, in big ways and small, as we go.

Enjoy your lovely evening and celebration.